Metacognitive factors in smoking: causal effects of maladaptive appraisals of cravings, thought suppression and nicotine withdrawal on craving severity

Cigarette smoking is directly responsible for the deaths of more than 45,000 Canadians each year. Although the majority of current smokers want to quit, smoking cessation can be extremely difficult. Since smokers are more likely to lapse after experiencing intense, persistent and distressing cravings, identifying factors that influence the severity of smoking-related thoughts, images and impulses is critical for understanding and preventing cessation relapse. Recent theories on the role of metacognitive processes in psychopathology hold promise for increasing our understanding of this important health issue. Metacognition refers to how people think about and react to unwanted thoughts and impulses. In her Master’s level research, Elizabeth found that among individuals attempting to quit smoking, metacognition is associated with nicotine craving severity and smoking cessation difficulty. Specifically, smokers who viewed their cravings as more important to control and more personally meaningful experienced more frequent, distressing and persistent cravings and were more likely to relapse one month later. Elizabeth is now building on this research, investigating the causal factors that contribute to personally meaningful interpretations of cravings, in relation to the effects of acute nicotine withdrawal and efforts to control thoughts about smoking. The results of Elizabeth’s research will help build understanding of the psychological factors that increase the risk for smoking relapse. They may also lead to innovative clinical strategies focused on appraisals and responses to cravings.